State of the Planet

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My Day with a Community Health Worker

Originally posted at

The other week I walked the footpaths of Nyaminia, a sub-location of the Millennium Village Project in Sauri, Kenya, to visit households with Richard*, a Community Health Worker (CHW). Going around with a CHW was eye-opening. It’s one thing to read about nutrition screenings and the use of mobile phones for health monitoring, but quite another to see it in action. Richard and I visited seven households where he took the nutrition measurements of children under-five with a simple tool called a “MUAC” – mid-upper arm circumference tool. This flexible ruler that goes around the arm of a child is an uncomplicated, effective field tool for identifying malnourished children under five.

After measuring the children, Richard then let me use his mobile phone to text in the results of the screening to a central database which records all the personalized health data the 108 CHWs send in.

A major benefit of this system, known as ChildCount+, is that it provides immediate feedback to the CHW, guiding their action. For instance, if any of the children we monitored had had a MUAC below 115 mm, Richard would have received a message to refer them to the clinic for treatment of Severe Acute Malnutrition. Similar feedback is provided for malaria cases. In one home, after texting in the results of the rapid malaria diagnostic test (positive) and the estimated weight of the child displaying malaria symptoms, the system sent back a text message of the appropriate dosage of Coartem the child should take. Although an experienced CHW may know these prescriptions by heart, each of these texts acts as a check of diagnosis and prescription.

I see great value in mobile systems such as the one used by the CHWs in Sauri. Beyond providing immediate feedback, this type of system can reinforce the learning of newer CHWs, increase accountability by quantitatively measuring the actions of CHWs, improve tracking of health and disease patterns in a community, inform resource allocations, and with proper monitoring and evaluation tools, assist in measuring the effectiveness of interventions.

Although I’ve been impressed with the use of ChildCount+ in the field, my time with Richard reminded me once again that an information system is only as good as its people and its tools. Although none of the children monitored were severely malnourished, there were some children clearly not receiving all the necessary micronutrients which the MUAC measurement did not capture. This could only be recognized and acted upon by a trained health worker like Richard who is familiar with the people he works with and has resources at his disposal. For the families of malnourished children, the CHW may refer the family to a clinic for supplementary or emergency feeding. For longer-term solutions he may refer the mother to the agriculture team to attend an upcoming gardening training, or talk to a facilitator about the family’s eligibility for subsidized fertilizer and improved seeds.

Richard himself had some critiques of the ChildCount+ and CHW systems. The texting of medical information takes time and errors do occur. As the CHW system has become more professionalized, responsibilities have expanded and many feel that the pay, a stipend provided by MVP, is far from adequate. Even though there are challenges, all the CHWs I’ve spoken with have seen an improvement in the nutrition status of the children in the region, and attribute these changes to MVP interventions such as door-to-door health screenings, nutrition training, and immediate clinic referrals for emergency and supplementary feeding.

For a short video of Community Health Workers using the mobile system in Sauri, Kenya, please click here.

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